Mania Research Articles

BIPOLAR DISORDER MANIC EPISODE WITH PSYCHOSIS : A CASE REPORT

Bipolar disorder (BD) is a psychiatric disorder that presents with manic and depressive episodes. The mood episodes appear as random and unpredictable episodes. The frequency and course of manic and depressive episodes may vary in each case and be determined by environmental factors as well as patient susceptibility.. A 25-year-old man, looks age appropriate, lacks self-care. He was taken to the emergency room because he was making noise about recommendations since 1 week before he was admitted to the hospital. 3 days before came to hospital was confused, easily emotional and had difficulty sleeping, talking to herself, having difficulty communicating, including being in a trance and starting to borrow and owe money to other people. Patients also see and hear sounds that other people do not hear. Further studies are needed for the evaluation of patients with bipolar disorder with psychosis and to acknowledge the treatment options with psychosocial educations as the support the treatment of bipolar disorder.

Dissecting clinical and biological heterogeneity in clinical states of bipolar disorder: a 10-year retrospective study from China.

To dissect clinical and biological heterogeneity in clinical states of bipolar disorder (BD), and investigate if neuropsychological symptomatology, comorbidity, vital signs, and blood laboratory indicators are predictors of distinct BD states. A retrospective BD cohort was established with data extracted from a Chinese hospital's electronic medical records (EMR) between 2009 and 2018. Subjects were inpatients with a main discharge diagnosis of BD and were assessed for clinical state at hospitalization. We categorized all subjects into manic state, depressive state, and mixed state. Four machine learning classifiers were utilized to classify the subjects. A Shapley additive explanations (SHAP) algorithm was applied to the classifiers to aid in quantifying and visualizing the contributions of each feature that drive patient-specific classifications. A sample of 3,085 records was included (38.54% as manic, 56.69% as depressive, and 4.77% as mixed state). Mixed state showed more severe suicidal ideation and psychomotor abnormalities, while depressive state showed more common anxiety, sleep, and somatic-related symptoms and more comorbid conditions. Higher levels of body temperature, pulse, and systolic and diastolic blood pressures were present during manic episodes. Xgboost achieved the best AUC of 88.54% in manic/depressive states classification; Logistic regression and Random forest achieved the best AUCs of 75.5 and 75% in manic/mixed states and depressive/mixed states classifications, respectively. Myocardial enzymes and the non-enzymatic antioxidant uric acid and bilirubin contributed significantly to distinguish BD clinical states. The observed novel biological associations with BD clinical states confirm that biological heterogeneity contributes to clinical heterogeneity of BD.

Protein folding and mental health: The impact of protein misfolding on neurological disorders

Major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SCZ) are psychiatric disorders that significantly impact an individual's ability to function effectively within society. MDD is characterized by persistent low mood, leading to symptoms such as anhedonia, feelings of worthlessness, and cognitive impairments. BD, another mood disorder, is typified by recurrent episodes of depression and mania or hypomania. The disorder is associated with increased risk of suicide, comorbid psychiatric conditions, and impaired functioning across various domains. SCZ, a severe psychiatric disorder primarily characterized by hallucinations, delusions, and disorganized thinking, affects approximately 1% of the global population. The cognitive, social, and occupational impairments associated with SCZ impose a substantial burden on affected individuals and their families. Even though it sounds like three completely different mental disorders, because of the high degree of matching of symptoms, we firmly believe that there is a relationship between these mental disorders. Protein folding is crucial for proper protein function, and misfolding can lead to neurodegenerative disorders. Through recent research findings, we found that the changes in A plaques and tau tangles appeared in the typical psychiatric diseases mentioned above. This paper explored the impact of protein misfolding, changes in A plaques, and tau tangles on neurological disorders, with a focus on depression, bipolar disorder, and schizophrenia, also examines the role of molecular chaperones in preventing misfolding and the impact of protein misfolding.

Brain functional changes across mood states in bipolar disorder: from a large-scale network perspective.

Exploring the neural basis related to different mood states is a critical issue for understanding the pathophysiology underlying mood switching in bipolar disorder (BD), but research has been scarce and inconsistent. Resting-state functional magnetic resonance imaging data were acquired from 162 patients with BD: 33 (hypo)manic, 64 euthymic, and 65 depressive, and 80 healthy controls (HCs). The differences of large-scale brain network functional connectivity (FC) between the four groups were compared and correlated with clinical characteristics. To validate the generalizability of our findings, we recruited a small longitudinal independent sample of BD patients (n = 11). In addition, we examined topological nodal properties across four groups as exploratory analysis. A specific strengthened pattern of network FC, predominantly involving the default mode network (DMN), was observed in (hypo)manic patients when compared with HCs and bipolar patients in other mood states. Longitudinal observation revealed an increase in several network FCs in patients during (hypo)manic episode. Both samples evidenced an increase in the FC between the DMN and ventral attention network, and between the DMN and limbic network (LN) related to (hypo)mania. The altered network connections were correlated with mania severity and positive affect. Bipolar depressive patients exhibited decreased FC within the LN compared with HCs. The exploratory analysis also revealed an increase in degree in (hypo)manic patients. Our findings identify a distributed pattern of large-scale network disturbances in the unique context of (hypo)mania and thus provide new evidence for our understanding of the neural mechanism of BD.

Real-world predictors of divorce among outpatients with bipolar disorder: sex differences and clinical implications

BackgroundBipolar disorder is a mental illness characterized by recurring episodes of mania and depression and is known to cause social impairment. Additionally, it has been revealed that bipolar disorder increases the risk of divorce and loss of family member support, which can worsen the prognosis. However, there is limited evidence regarding the predictive factors of divorce among patients with bipolar disorder in real-world settings.MethodsThis study utilized an observational approach and involved psychiatrists from 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics. They were requested to conduct a retrospective review of medical records and complete a questionnaire focused on patients diagnosed with bipolar disorder. The data collection period for baseline patient characteristics spanned from September to October 2017. Next, we investigated the incidence of divorce over a 2-year period, ranging from baseline to September to October 2019.ResultsA total of 1071 outpatients with bipolar disorder were included in the analysis, and 2.8% (30/1071) experienced divorce during the first 2 years of observation. The incidence of divorce in this population was considerably higher than that in the general Japanese population. Binomial logistic regression analysis confirmed that a younger baseline age and lower BMI values were statistically significant predictors of divorce occurrence for all study participants. The predictors of divorce were then examined separately by sex. The results revealed that for men, a younger age at baseline and having bipolar I disorder compared to bipolar II disorder were statistically significant predictors of divorce. In contrast, for women, having a lower BMI and using anxiolytics emerged as statistically significant predictors of divorce.ConclusionsIn this study, a younger baseline age and lower BMI values were statistically significant predictors of divorce in patients with bipolar disorder. Notably, the predictors of divorce varied significantly between men and women. These findings provide important insights from a family perspective regarding social support for individuals with bipolar disorder in real-world clinical settings.

Cerebellar-cortical connectivity in bipolar disorder: Exploring the regulatory action of modafinil

Bipolar and related disorders (BD) are characterized by frequent deregulation and changes in mood and energy states. The neurobiological mechanisms underlying these changes remain unknown. The cerebellum has recently demonstrated its role in emotional and behavioral regulation in psychiatric illnesses and may be an essential structure for mood regulation and clinical stabilization in bipolar disorder. Modafinil has demonstrated efficacy in improving and controlling symptoms of bipolar depression through its control of symptoms such as fatigue, drowsiness, and regulation of wakefulness levels. However, since this drug also showed effects on mood improvement and treated BD patients do not have an increased risk of manic episodes, it appears to have mood-stabilizing effects whose neurobiological mechanisms are not yet established. In this regard, recent research has demonstrated the modulating effect of modafinil on the connectivity of the cerebellum and cortex. This article explores the interaction between this effect and its possible interference in maintaining euthymia in bipolar disorder.

Factors associated with suicide attempts in the antecedent illness trajectory of bipolar disorder and schizophrenia

BackgroundFactors associated with suicide attempts during the antecedent illness trajectory of bipolar disorder (BD) and schizophrenia (SZ) are poorly understood.MethodsUtilizing the Rochester Epidemiology Project, individuals born after 1985 in Olmsted County, MN, presented with first episode mania (FEM) or psychosis (FEP), subsequently diagnosed with BD or SZ were identified. Patient demographics, suicidal ideation with plan, self-harm, suicide attempts, psychiatric hospitalizations, substance use, and childhood adversities were quantified using the electronic health record. Analyses pooled BD and SZ groups with a transdiagnostic approach given the two diseases were not yet differentiated. Factors associated with suicide attempts were examined using bivariate methods and multivariable logistic regression modeling.ResultsA total of 205 individuals with FEM or FEP (BD = 74, SZ = 131) were included. Suicide attempts were identified in 39 (19%) patients. Those with suicide attempts during antecedent illness trajectory were more likely to be female, victims of domestic violence or bullying behavior, and have higher rates of psychiatric hospitalizations, suicidal ideation with plan and/or self-harm, as well as alcohol, drug, and nicotine use before FEM/FEP onset. Based on multivariable logistic regression, three factors remained independently associated with suicidal attempts: psychiatric hospitalization (OR = 5.84, 95% CI 2.09–16.33, p < 0.001), self-harm (OR = 3.46, 95% CI 1.29–9.30, p = 0.014), and nicotine use (OR = 3.02, 95% CI 1.17–7.76, p = 0.022).ConclusionSuicidal attempts were prevalent during the antecedents of BD and SZ and were associated with several risk factors before FEM/FEP. Their clinical recognition could contribute to improve early prediction and prevention of suicide during the antecedent illness trajectory of BD and SZ.

Delirium and Pseudoparkinsonism in a Bipolar Patient: Case Report

Background Bipolar patients are at higher risk of delirium, in comparison to other psychiatric patients, regardless of being under lithium treatment. Indeed, lithium and antipsychotics are the mainstay drugs in the management of bipolar disorder. In clinical practice, the combinations of these drugs are commonly used in the management of acute phase of mania. Despite rare previous cases of olanzapine-associated delirium and cases of delirium with extrapyramidal signs due to a lithium-olanzapine combination therapy, these are mainly reported in elderly or severely ill patients. Case Presentation This case report illustrates a complex neuropsychiatric syndrome characterized by olanzapine-associated delirium alongside parkinsonism induced by aripiprazole, during a severe manic episode, in an antipsychotic-naïve young adult bipolar patient, under lithium maintenance treatment. Conclusions This case highlights the need for caution regarding delirium and extrapyramidal symptoms when treating antipsychotic-naïve bipolar patients under lithium maintenance therapy. The risk factors and the underlying physiopathology of this iatrogenic neuropsychiatric syndrome are discussed. We hypothesise a central cholinergic antagonism in the pathophysiology for delirium, and both pharmacokinetic and pharmacodynamic mechanisms for Parkinsonism, namely a putative flaw functioning of CYP2D6 or CYP3A4 cytochromes, bringing about a failure in metabolising aripiprazole at a normal rate, and a synergistic effect of lithium and antipsychotics on dopaminergic blockade.

Regional Homogeneity of the Left Posterior Cingulate Gyrus May Be a Potential Imaging Biomarker of Manic Episodes in First-Episode, Drug-Naive Bipolar Disorder.

Abnormal brain networks with emotional response in bipolar disorder (BD). However, there have been few studies on the local consistency between manic episodes in drug-naive first-episode BD patients and healthy controls (HCs). The purpose of this study is to evaluate the utility of neural activity values analyzed by Regional Homogeneity (ReHo). Thirty-seven manic episodes in first-episode, drug-naive BD patients and 37 HCs participated in resting-state functional magnetic resonance rescanning and scale estimation. Reho and receiver operating characteristic (ROC) curve methods were used to analyze the imaging data. Support vector machine (SVM) method was used to analyze ReHo in different brain regions. Compared to HCs, ReHo increased in the left middle temporal gyrus (MTG.L), posterior cingulate gyrus (PCG), inferior parietal gyrus, and bilateral angular gyrus, and decreased in the left dorsolateral superior frontal gyrus in target group. The ROC results showed that the ReHo value of the left PCG could discriminate the target group from the HCs, and the AUC was 0.8766. In addition, the results of the support vector machine show that the increase in ReHo value in the left PCG can effectively discriminate the patients from the controls, with accuracy, sensitivity, and specificity of 86.02%, 86.49%, and 81.08%, respectively. The increased activity of the left PCG may contribute new evidence of participation in the pathophysiology of manic episodes in first-episode, drug-naive BD patients. The Reho value of the left posterior cingulate gyrus may be a potential neuroimaging biomarker to discriminate target group from HCs.

PSYCHOSOCIAL INTERVENTION FOR REDUCING RELAPSE AND IMPROVING TREATMENT ADHERENCE IN BIPOLAR AFFECTIVE DISORDER WITH POOR SOCIO-OCCUPATIONAL FUNCTIONING AND HIGH EXPRESSED EMOTION IN THE FAMILY: A CASE REPORT

Introduction: Bipolar affective disorder (BPAD) is a chronic psychiatric disorder with an admixture of frequent and recurrent episodes of mania, hypomania, depression, or mixed episodes. More than 1% of the world's population and at least 0.3% of the Indian population are affected by BPAD. We have chosen a case of BPAD with multiple episodes to study the impact of psychosocial intervention in the management of the illness of the affected person and family. The index client, a male, Presentation of the case: 32 years of age, visited the Institute of Psychiatry (IOP) with caregivers and was referred to the psychiatric social work department of the IOP on April 24, 2019, with symptoms of mania and psychosis. He had 7-years history of psychiatric illness, including multiple episodes of mania and depression, as well as frequent irregular medication; burden and conict, insufcient social support, poor communication and interaction patterns, poor coping and problem-solving skills in the family. Therapists imparted Interpersonal and Social Rhythm Therapy (IPSRT) and family-focused therapy to the client and family members. It was found that there Discussion: was a signicant difference between pre- and postpsychosocial interventions in the life and wellbeing of a person with BPAD and his family. Post intervention, client's level of social and occupational functioning was increased, high expressed emotion had been notably decreased, adaptive patterns had been improved, and cohesion in the family had been strengthened. The client and his family members learned to prevent development of future episodes. Conclusion: Psychiatric social work interventions have been a key area in the management of BPAD involving the family, which helps in maintaining a prolonged euthymic period and better treatment compliance.

Clinical Manifestations.

Neurodegenerative pathologies, including tau depositions, have been implicated in late-onset depression (LOD), while there is a lack of in-vivo evidence for the neuropathological basis of late-onset bipolar disorder (LOBD) despite postmortem findings of cerebral tau accumulations. The current study aimed to assess tau pathologies in LOBD and LOD patients positron emission tomography (PET) with 18F-florzolotau, a radioligand for Alzheimer's disease (AD) and non-AD tau fibrils. We studied LOBD and LOD patients who developed the first episode of mania or depression after age 45. Twenty-one patients with LOBD (68.8 ± 9.6 years old; 11 females), 15 patients with LOD (73.0 ± 5.8 years old; 11 females), and 39 age-matched healthy controls (HCs) (67.1 ± 9.1 years old; 19 females) underwent tau and amyloid PET scans with 18F-florzolotau and 11C-PiB, respectively. Amyloid positivity was determined by a visual read of 11C-PiB-PET images, and tau depositions were assessed by calculating standardized uptake value ratios (SUVRs) in 52 regions covering the cerebral grey matter and basal ganglia to the optimized reference tissue. All SUVRs were corrected for age and sex and converted to Z-score relative to HCs. The positivity and topology of tau pathologies were determined according to the presence of a region with a Z-score ≥ 2.0. 18F-florzolotau-PET positivity was observed in 13 LOBD (62%), 7 LOD (47%), and 11 HC (28%) subjects, whereas 4 LOBD, 4 LOD, and no HC individuals were 11C-PiB-PET-positive. A significant difference in the prevalence of tau pathologies was only found between LOBD and HCs (P = 0.043, corrected for multiple comparisons). Tau topologies in the cases with 11C-PiB-PET-positive AD pathologies consisted of predominant frontal (1 LOBD and 3 LODs), lateral temporal (3 LOBDs and 1 LOD), and posterior (1 LOBD) accumulations. Meanwhile, tau pathologies in 11C-PiB-negative cases showed predominant frontal (2 LOBDs and 1 LOD), temporal (1 LOBD and 1 LOD), posterior (4 LOBDs and 1 LOD), and basal ganglia (2 LOBDs) localizations. Our findings suggest that a significant subset of LOBD patients harbor tau lesions linked to various AD subtypes and non-AD tauopathies indicative of distinct early-stage frontotemporal lobar degeneration subcategories.

Reduced mitochondrial respiratory capacity in patients with acute episodes of bipolar disorder: Could bipolar disorder be a state-dependent mitochondrial disease?

Bipolar disorder (BD) is a chronic and recurrent disease characterized by acute mood episodes and periods of euthymia. The available literature postulates that a biphasic dysregulation of mitochondrial bioenergetics might underpin the neurobiology of BD. However, most studies focused on inter-subject differences rather than intra-subject variations between different mood states. To test this hypothesis, in this preliminary proof-of-concept study, we measured in vivo mitochondrial respiration in patients with BD during a mood episode and investigated differences compared to healthy controls (HC) and to the same patients upon clinical remission. This longitudinal study recruited 20 patients with BD admitted to our acute psychiatric ward with a manic (n = 15) or depressive (n = 5) episode, and 10 matched HC. We assessed manic and depressive symptoms using standardized psychometric scales. Different mitochondrial oxygen consumption rates (OCRs: Routine, Leak, electron transport chain [ETC], Rox) were assessed during the acute episode (T0) and after clinical remission (T1) using high-resolution respirometry at 37°C by polarographic oxygen sensors in a two-chamber Oxygraph-2k system in one million of peripheral blood mononuclear cells (PMBC). Specific OCRs were expressed as mean ± SD in picomoles of oxygen per million cells. Significant results were adjusted for age, sex, and body mass index. The longitudinal analysis showed a significant increase in the maximal oxygen consumption capacity (ETC) in clinical remission (25.7 ± 16.7) compared to the acute episodes (19.1 ± 11.8, p = 0.025), and was observed separately for patients admitted with a manic episode (29.2 ± 18.9 in T1, 22.3 ± 11.9 in T0, p = 0.076), and at a trend-level for patients admitted with a depressive episode (15.4 ± 3.9 in T1 compared to 9.4 ± 3.2 in T0, p = 0.107). Compared to HC, significant differences were observed in ETC in patients with a bipolar mood episode (H = 11.7; p = 0.003). Individuals with bipolar depression showed lower ETC than those with a manic episode (t = -3.7, p = 0.001). Also, significant differences were observed in ETC rates between HC and bipolar depression (Z = 1.000, p = 0.005). Bioenergetic and mitochondrial dysregulation could be present in both manic and depressive phases in BD and, importantly, they may restore after clinical remission. These preliminary results suggest that mitochondrial respiratory capacity could be a biomarker of illness activity and clinical response in BD. Further studies with larger samples and similar approaches are needed to confirm these results and identify potential biomarkers in different phases of the disease.

Elevated Brain-Derived Neurotrophic Factor Levels During Depressive Mixed States.

Neurotrophin-like brain-derived neurotrophic factor (BDNF) and pro-inflammatory cytokines may modulate the pathophysiology of mood disorders. Although several studies show alterations in these biomarkers during the depressive, manic, and euthymic states of mood disorders, evidence is lacking for those in a mixed state. Therefore, this study aimed to investigate the relationship between the depressive mixed state (DMX) and peripheral neurobiological factors. We enrolled 136 patients with major depressive episodes. Depressive symptoms were assessed using the Quick Inventory of Depressive Symptomatology Self-Report Japanese version (QIDS-SR-J). The severity of DMX was assessed using the self-administered 12-item questionnaire (DMX-12). Categorical screening as DMX-positive (n=54) was determined by a cutoff score of 13 or more in the specific eight symptoms from the DMX-12; the remaining were DMX-negative (n=82). Serum BDNF, tumor necrosis factor-α, highsensitivity C-reactive protein, and interleukin-6 levels were measured. When comparing biomarkers between the DMX-positive and DMX-negative groups, higher serum BDNF concentration in the DMX-positive group than in the DMX-negative group was the only significant finding (p=0.009). A positive correlation existed between the total score of the eight specific symptoms of DMX-12 and the BDNF concentration (r=0.190, p=0.027). After adjustment for confounders, logistic regression analysis revealed that BDNF (odds ratio [OR]=1.07, 95% confidence interval [CI]=1.00-1.14, p=0.045), bipolar diagnosis (OR=3.43, 95% CI=1.36-8.66, p=0.009), and total QIDS-SR-J score (OR=1.29, 95% CI=1.15-1.43, p<0.001) were significantly associated with DMX positivity. BDNF was positively associated with DMX severity, suggesting that higher BDNF concentrations may be involved in the pathophysiology of DMX.

Do you feel up when you go up? A pilot study of a virtual reality manic-like mood induction paradigm.

In order to understand the working mechanisms of mania, it is necessary to perform studies during the onset of manic (-like) mood states. However, clinical mania is difficult to examine experimentally. A viable method to study manic mood like states is mood induction, but mood induction tasks thus far show variable effectiveness. In this pilot study, a new paradigm to induce mood through virtual reality (VR) is examined. Both state characteristics, namely changes in emotion, and trait characteristics, such as high and low scores on the hypomanic personality scale (HPS), were measured in 65 students. These students participated in either a neutral VR mood induction or an activating VR mood induction in which excitement, goal directedness, and tension (being aspects of mania) were induced. All participants performed a risk-taking behavioural task, Balloon Analogue Risk Task (BART). The experimental VR task induced excitement and tension. In participants with higher sensitivity to hypomanic personality (HPS), irritation increased in response to activation whereas it decreased in the low HPS group, and excitement increased more steeply in the low HPS group. There were no effects on the behavioural task. The VR task is effective in inducing relevant state aspects of hypomania and is suitable as a paradigm for future experimental studies. Activation of dual affective states (excitement and tension) is an essential aspect in manic-like mood induction paradigms.

Periodontal conditions and association of periodontitis with oral-health-related quality of life in patients experiencing different episodes of bipolar disorder compared with healthy controls.

The aim of the present cross-sectional study was to evaluate periodontal conditions and the association of periodontitis with oral-health-related quality of life (OHRQoL) in patients with a history of bipolar disorder. A total of 160 participants were recruited in four groups for the study: 40 patients with euthymic episodes, 40 patients with depression, 40 patients with manic episodes and 40 systemically healthy individuals. Clinical periodontal parameters were recorded. Oral Health Impact Profile (OHIP-14) was used to measure the impact of oral health on the quality of life. Bipolar disorder groups exhibited generally higher clinical parameters compared with the control group (p < .05). OHIP-14 total score (β = 3.32, 95% confidence interval [CI]: 0.08-6.56, p = .044), functional limitation (β = .89, 95% CI: 0.27-1.49, p = .005) and physical pain (β = .64, 95% CI: 0.01-1.27, p = .046) were associated with bipolar depression episodes. Psychological discomfort was associated with the presence of generalized periodontitis (β = .76, 95% CI: 0.01-1.51, p = .047) and psychological disability was associated with the presence of stage III-IV (β = .83, 95% CI: 0.07-1.59, p = .033) and generalized (β = .75, 95% CI: 0.07-1.42, p = .029) periodontitis. According to this study, a history of bipolar disorder episodes (exposure) may be associated with increased prevalence and severity of periodontitis and related reported OHRQoL impacts (outcomes). Bipolar depression episodes had a higher impact on OHRQoL than other bipolar episodes.

Melatonin MT1 receptors as a target for the psychopharmacology of bipolar disorder: A translational study

The treatment of bipolar disorder (BD) still remains a challenge. Melatonin (MLT), acting through its two receptors MT1 and MT2, plays a key role in regulating circadian rhythms which are dysfunctional in BD. Using a translational approach, we examined the implication and potential of MT1 receptors in the pathophysiology and psychopharmacology of BD. We employed a murine model of the manic phase of BD (Clock mutant (ClockΔ19) mice) to study the activation of MT1 receptors by UCM871, a selective partial agonist, in behavioral pharmacology tests and in-vivo electrophysiology. We then performed a high-resolution Nuclear Magnetic Resonance study on isolated membranes to characterize the molecular mechanism of interaction of UCM871. Finally, in a cohort of BD patients, we investigated the link between clinical measures of BD and genetic variants located in the MT1 receptor and CLOCK genes. We demonstrated that: 1) UCM871 can revert behavioral and electrophysiological abnormalities of ClockΔ19 mice; 2) UCM871 promotes the activation state of MT1 receptors; 3) there is a significant association between the number of severe manic episodes and MLT levels, depending on the genetic configuration of the MT1 rs2165666 variant. Overall, this work lends support to the potentiality of MT1 receptors as target for the treatment of BD.

Is intravenous valproate more efficacious than oral valproate for inpatients with bipolar I disorder with a manic or depressive episode and concomitant symptoms of opposite polarity?

Valproic acid (VPA) is a commonly prescribed mood stabilizer, available in both oral (OS) and intravenous (IV) formulations. However, few studies have compared their safety and efficacy. This retrospective study aimed to investigate the safety and efficacy of and IV-VPA in patients with Bipolar Disorder. Fifty patients with Bipolar Disorder experiencing a manic or depressive episode, with concomitant symptoms of opposite polarity, admitted to our inpatient unit and treated with IV-VPA were included in a retrospective, single-centre, non-randomized, open-label, parallel-group comparative study. Fifty patients experiencing a manic or depressive episode, with concomitant symptoms of opposite polarity, treated with oral-VPA and selected among those who were admitted to the inpatient unit prior to the introduction of IV-VPA in our clinical practice, were included as the control group (matched based on age, gender and clinical scales score at baseline). The Clinical Global Impression (CGI), Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (HAM-A) scores were recorded at baseline, after 3 days of treatment and discharge from the inpatient unit. Patients were asked to respond on the basis of the symptoms present on the day the scale was administered. Response rate and the presence of adverse effects were also recorded. Both patients treated with oral and IV-VPA demonstrated significant improvements in all psychometric scales (p < 0.001). However, the IV group exhibited superior efficacy, with significantly lower scores on the CGI, YMRS, MADRS and HAM-A scales on Day 3 and at discharge from the inpatient unit. The IV-VPA treatment showed higher response rates on all psychometric scales, and no adverse effects were reported in either group. This retrospective study supports the use of IV-VPA as a more efficacious treatment option for patients with Bipolar Disorder, particularly in acute settings where rapid symptom improvement is crucial. Both oral and IV-VPA were found to be safe and well-tolerated.

Diagnosis and treatment of unipolar and bipolar depression in the early stage

Bipolar Disorder and Unipolar Depressive Disorder are both mental disorders that contain depressive episodes, and the patterns of depression are similar between the two diseases. People are likely to meet their clinicians for the first time when they experience depression while there is no significant evidence of the existence of mania episodesthe other episode of bipolar disorder. Therefore, it is likely that the clinicians misdiagnose the disorder, thus prescribing the wrong medication or applying therapies harmful to patients. For example, some antidepressants will stimulate the mania episode of bipolar patients, increasing the frequency of switch between extreme depression and mania, thus developing the results of bipolar disorder in the patients. At the same time, some mood stabilizers are not that effective to cure major depression compared to medication specialized in treating depression. This article aims at providing several diagnostic methods that can differentiate bipolar and unipolar disorders, and introducing some plausible therapies that work for the two disorders at the same time without severe harm or exacerbation.

Manic switch during vortioxetine treatment: New medicine, new issue

Antidepressants have been linked to manic or hypomanic episodes in patient being treated for unipolar or bipolar depression. Knowledge of the risk of manic or hypomanic switch associated with a specific antidepressant assists clinicians in analyzing the risk-benefit ratio and finally prescribing an antidepressant of choice in a specific instance. Vortioxetine is now frequently utilized in clinical practice to treat unipolar depression. However, there is insufficient data on manic or hypomanic transition during vortioxetine treatment of unipolar depression. The purpose of this case report is to add to the existing literature on the vortioxetine-induced manic switch and the importance of considering risk factors before starting anti-depressants. Vortioxetine should be used with caution in patients with mood disorders.

Efficacy of spironolactone as adjunctive therapy to sodium valproate in bipolar-I disorder: A double-blind, randomized, placebo-controlled clinical trial.

Treatment of mood and cognitive symptoms of patients with bipolar disorder is associated with many complications and is generally not associated with therapeutic satisfaction. In this clinical trial, we evaluated the effectiveness of spironolactone in controlling mood and cognitive symptoms, sleep quality, appetite, and body mass index in patients with bipolar disorder in manic episodes. Sixty inpatients with bipolar disorder in manic episodes were treated with spironolactone/placebo in an 8-week randomized, double-blind, placebo-controlled clinical trial. They were evaluated using the Young Mania Rating Scale (YMRS), mini-mental state examination (MMSE), Pittsburgh sleep quality index, Simplified Nutritional Appetite Questionnaire, and body mass index in weeks 1, 4, and 8. For cognitive impairment (MMSE), there were significant interaction effects of group and time at week 8 (B=-1.60, SE=0.69, t=-2.33, p=.021) such that individuals in the spironolactone group experienced more improvement in their cognitive performance. For manic symptoms (YMRS), there were no significant interaction effects of group and time at week 8 (B=-2.53, SE=1.46, t=-1.73, p=.085). Considering the promising findings in this clinical trial, further study of spironolactone as adjunctive therapy in bipolar disorder in manic episodes with larger sample sizes, multicenter settings, and longer follow-ups are recommended.